IBD Flashcards
Describe the broad shared features of ulcerative colitis & Crohn’s disease - timecourse, kind of disease, cause and extra effects.
Both are chronic, relapsing and immune-mediated. Both have genetic and environmental factors in aetiology and can have extra-intestinal manifestations.
Describe the pathological findings of ulcerative colitis - location (3 features) and 4 features on histology.
Starts from rectum and extends proximally, continuous, superficial inflammation of mucosa +/-submucosa. Histology: lymphocytes, crypt abscesses/distortion, few goblet cells, no granulomas.
Describe the pathological findings of Crohn’s disease - location (3 features) and 3 features on histology.
Any part of the GIT affected (usually terminal ileum/ascending colon), skip lesions (discontinuous) with cobblestoning, deep ulcers/transmural. Histology: lympocytes, macrophages and granulomas in 50%.
Comparing UC & Crohn’s disease (CD), in which one is each of fever, rectal bleeding, abdominal pain, strictures, fistulae, surgical recurrence and smoking & appendectomy as protectants more likely?
CD: fever, abdo pain, strictures/fistulae more likely. Surgical recurrence common. Smoking increases risk.
UC: Rectal bleed more common. No recurrence post-colectomy, smoking/appendectomy protects.
What are 4 GIT symptoms IBD patients may present with? What other symptoms are possible?
Abdo pain, diarrhoea (urgency & tenesmus - incomplete emptying), rectal bleed, perianal lesions. Also, systemic symptoms: fever, weight loss, anorexia. Plus extra-intestinal manifestations in 10-20%
What are 4 dermatological, 3 rheumatological and 2 ocular manifestations of IBD? Roughly how common are they? Are they equally common in UC and CD?
Erythema nodosum, pyoderma gangrenosum, perianal skin tags, oral mucosal lesions. Peripheral arthritis, ankylosing spondylitis. Uveitis (severe), episcleritis (benign). Derm & rheum about 10-20% of CD patients, skin tags in 75% & ocular in 3-4%. All less in UC.
Which extra-intestinal manifestation of IBD is more common in UC? What does this combination also increase the risk of?
Primary sclerosing cholangitis. PSC + UC together increases risk of colorectal cancer.
What are 6 distinguishing factors between IBD and IBS?
In IBD, get abnormal lab tests, nocturnal symptoms, systemic symptoms, continuous symptoms, PR bleeding, iron deficiencies & anaemia.
What are the short and long term goals of treatment in IBD? What are 2 risks of undertreating and overtreating?
Short: induce remission & relieve symptoms. Long: maintain remission, prevent complications, reduce need for hospitalisation/surgery. Undertreat: complications, surgery. Over: costs, SE (infections/cancer)
What drugs can be used to induce remission in both UC and CD? What drugs are well-tolerated for remission in UC?
Steroids, but can’t use long term. In UC, can use 5-aminosalicylates & sulfasalazine to induce & maintain remission. Few SE (diarrhoea 3%, headache, nausea 2%)
What drugs are generally used in remission of CD? Effects and side effects.
Thiopurines - azathioprine, 6-mercaptopurine. Inhibit T/B cell proliferation, induce T cell apoptosis. SE: hepatotoxic, bone marrow suppression + lymphoma, pancreatitis, N/V.
What are 3 drugs used in severe IBD? Side effects and indications?
Methotrexate (toxic: hepatotoxic, bone marrow suppression, teratogen, nausea). Cyclosporine - in short term rescue of UC. SE: nephrotoxic neurotoxic hypertension. Biologics - antiTNF antibodies (infliximab, adalimumab) in severe cases, expensive. SE: infections (TB), lymphoma, CCF, infusion reaction.
Describe the general medical treatment in UC and CD.
UC: 5-aminosalicylates/sulfasalazine (+ steroids if moderate) and consider adding thiopurine. Severe: steroids, biologic, surgery.
CD: steroids for remission, add thiopurine or methotrexate later. Stop smoking.
When is surgery indicated in UC and CD: for both and for each individually?
Both: medical therpay ineffective or intolerable. CD: for complications (stricture, fistula, abscess). UC: for cancer/dysplasia or fulminant disease (toxic megacolon)
